CONCORD, NH – School and child-care providers peppered top state officials with questions about CDC’s new quarantine and isolation guidance in its regular, virtual briefing Wednesday, telling them it is making their job harder.
Dr. Benjamin Chan, the state epidemiologist, recognized over 200 unanswered questions in the chatbox at the end of the briefing, and said the state will adopt the new guidelines that reduce from 10 to 5 the number of days people need to isolate and quarantine after illness or exposure to COVID-19.
But Chan acknowledged that he is hearing the concerns of the school nurses and child-care providers to this change and that it will add to the burden that is already out there to manage the healthcare crisis in these congregate settings.
Chan said some questions do remain and more detailed guidance information is forthcoming.
“This is going to be a transitionary process,” Chan said.
Particularly problematic is the matter for child-care settings where children are too young to wear masks or be vaccinated. The details are just not out there yet, Chan acknowledged.
CDC’s new guidance can be read here.
They relate to isolation and quarantine. By definition, isolation refers to people who are sick or have tested positive while quarantine relates to people who have been exposed.
Both categories of people need to stay home for five days, Chan said.
While still waiting for further guidance on various settings, the new guidance is not supposed to apply to health-care settings or homeless shelters, and department of corrections facilities. Questions about residential colleges and universities are not entirely clear, Chan said.
Child-care settings are also a question mark but there will be more guidance to follow.
There is a change in the new CDC guidance in relation to the definition of those who are fully vaccinated to include boosters after six months of being fully vaccinated.
To shorten the duration of isolation and quarantine to five days, the CDC now recommends individuals stay home at least five days, watch for symptoms for 10 days, wear a well-fitting face mask around other people for at least days six through 10, and people should continue to avoid immunocompromised people and travel for at least 10 days after exposure.
For isolation, anyone who tests positive or is waiting for results and believes they are sick should stay home for at least five days, including people with whom they live.
To end isolation, one would need to be free of symptoms after five days. If on day six, they still have a fever or another symptom they still need to isolate at least another 24 hours, Chan said.
Rationale
Chan explained the rationale around the CDC guidance changes related to infection onset data and societal needs and the difference with the Omicron variant.
He said the average risk of infection is two to four days before symptom onset to at least eight days after. He said 31 percent remain infectious after five days.
With quarantine, Omicron has a shorter incubation period of three days, and it is part of the rationale for shortening the period. Societal needs for the change include mental, emotional, and physical health, the need for continued education, and financial impacts of the virus “so changes are based in finance but trying to balance the competing priorities.”
As isolation and quarantine periods decrease there is a need to increase strategies to prevent the spread, Chan said, including vaccination, boosters, face mask-wearing and, where possible, limiting group sizes, screening testing, increasing ventilation, and good hand hygiene.
“There is no one strategy alone that is going to stop the spread,” Chan said. “We rely on a multi-layer approach.”
COVID-19 Cases Rising
The change comes at a time when nationally the daily incidence of COVID-19 has experienced a dramatic exponential rise since school vacation began in December, Chan said.
There are almost 500,000 new cases per day of COVID-19 and that is trending dramatically upward, he said.
New Hampshire, he said, has been bouncing between 1,000 and 1,300 new cases a day but it has plateaued at 1,200 which he said is a “very, very high level and we remain at risk for it going higher due to Omicron variant.”
While the state test positivity rate is right around 20 percent, it will become less reliable with more in-home testing going on and fewer people reporting their illnesses.
Hospitalizations have plateaued in New Hampshire but are high at 370 on average, he said.
As the new variant Omicron increases in transmission, Chan said, the risk for hospitalization and deaths is there.
He said the state continues to see high numbers of people dying from COVID-19 with the average at about 10 people a day since September.
School Clusters
Clusters of COVID-19 in schools have gone down since the holidays but there is an expectation that the size in schools and child-care centers is on the rise. For schools K-12, for the first half of this current school year, there have been 444 before the break and almost 12 average cases per cluster.
“We ended December with 132 (active) clusters averaging 14 cases,” which Chan said is quite a high number.
Over the holiday break, some clusters closed but still, there are 72 open and active clusters in schools. The number of child-care clusters total 90 through December with an average of 9.5 people per cluster. There were 24 active clusters before the holidays and currently the state has 15 active child-care clusters.
The DHHS staff will continue with regular calls with school officials and healthcare providers as a mechanism to provide guidance and answers to people on the ground who need to implement the guidance.
The meetings, virtually, are held the first and third Wednesday of each month for an hour beginning at 3:30 p.m. A link with information on the meeting can be found here https://www.covid19.nh.gov/resources/schools
